Hepatocellular carcinoma

Hepatocellular carcinoma is one of the cancers with the highest mortality rate, being the third leading cause of cancer-related death.

Symptoms

In early stages, the disease is asymptomatic, meaning there are no clinical manifestations. In advanced stages, some of the following symptoms may appear:

• Abdominal pain or tenderness
• Abdominal enlargement (ascites)
• Yellowing of the skin or eyes (jaundice)
• Tendency to bleed or form bruises
• Unexplained weight loss

Who does the disease affect?

In more than 80% of cases, hepatocellular carcinoma occurs in patients with underlying liver disease, especially liver cirrhosis.

Diagnosis

Screening is important for diagnosing the disease at early stages, which is the ideal time to apply curative-intent treatment.

The diagnostic tests and procedures used depend on the patient profile:

• Patients at risk with known liver disease: Screening should be performed every six months using ultrasound. If a nodule is detected, contrast imaging tests such as CT scan or contrast-enhanced MRI are performed to confirm the diagnosis. In some cases, a liver biopsy is required, which involves extracting tumor tissue.
• Patients with unknown predisposing factors and not in a screening program: Usually diagnosed after the appearance of initial symptoms, using the following diagnostic tests:
  • Imaging tests such as CT scans and MRI
  • Tumor biopsy to extract liver tissue for histopathological examination

Usual treatment

Treatment for hepatocellular carcinoma varies for each patient, depending on tumor burden, liver function, and overall health status.

The most commonly used treatments are:

• Surgical: Resection surgery and liver transplantation, applicable in early stages
• Locoregional: Aimed at destroying tumor cells through direct ablation (radiofrequency ablation, microwave ablation, cryoablation, etc.) or via endovascular methods (transarterial chemoembolization or radioembolization)
• Systemic: Used mainly in advanced stages, currently including immunotherapy drugs and tyrosine kinase inhibitors

Survival in advanced stages has improved significantly thanks to the successful results of treatment combinations that include immunotherapy. Many patients have benefited and continue to benefit from these treatments before their official approval and commercialization through participation in clinical trials.

Most common tests

The most common diagnostic tests for this condition are ultrasound, CT scan, contrast-enhanced MRI, and biopsy. Blood tests are also used both for diagnosis and follow-up in daily clinical practice.

Prevention

The best way to prevent hepatocellular carcinoma is to avoid risk factors, such as alcohol consumption and smoking, control diabetes (a key component of metabolic syndrome associated with fatty liver disease), and prevent or treat hepatitis B and C infections.